Efficacy of Topical Rosemary Extract Lotion Versus Topical 2% Ketoconazole Lotion in the Treatment of Seborrheic Dermatitis: A Double Blind Randomized Controlled Clinical Trial

Efficacy of Topical Rosemary Extract Lotion Versus Topical 2% Ketoconazole Lotion in the Treatment of Seborrheic Dermatitis: A Double Blind Randomized Controlled Clinical Trial

Authors

  • Maryam Sadat Sadati Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Fateme Alesana Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Maryam Hekmat Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  • Mohammad Mahdi Parvizi Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Keywords:

Rosmarinus, Herbal Medicine, Seborrheic dermatitis, Skin Diseases, complementary therapies

Abstract

Introduction: Seborrheic dermatitis manifests as greasy, itchy lesions, commonly affecting sebum-rich areas like the scalp and face. Its prevalence is 11.6% in the general population, with various internal and environmental factors contributing to its development.

Objectives: This study aimed to compare the efficacy of rosemary extract lotion in the treatment of seborrheic dermatitis in comparison with topical 2% ketoconazole lotion.

Methods: This double-blind, randomized clinical trial included 42 patients with scalp seborrheic dermatitis, divided into rosemary and ketoconazole lotion groups. Both lotions were applied twice daily for 2 months. The severity of scalp dandruff was assessed using the Adherent Scalp Flaking Score. Itchiness of the scalp and quality of life were assessed using itchy quant and the Dermatology Life Quality Index (DLQI), respectively. Stata software was applied for statistical analysis.

Results: The reduction in the Adherent Scalp Flaking Score score was statistically significant the ketoconazole group compared to the patients in the rosemary group (P value = 0.011). However, the reduction in itching score was statistically significant more in the rosemary group at the end of the first and second months in comparison to the ketoconazole group (P value < 0.001). The statistical analysis demonstrated no significant difference in the reduction of DLQI scores between the rosemary and ketoconazole groups at the end of 1 and 2 months after starting the treatment in both crud and adjustment with base-line score analysis. 

Conclusion: Both rosemary and ketoconazole lotions were effective in treating scalp seborrheic dermatitis and decreasing the patient's DLQI score. 

References

Borda LJ, Perper M, Keri JE. Treatment of seborrheic dermatitis: a comprehensive review. Journal of Dermatological Treatment 2019;30(2):158-69

Akbaş A, Kılınç F, Şener S, Hayran Y. Vitamin D levels in patients with seborrheic dermatitis. Revista da Associação Médica Brasileira 2023;69:e20230022

Dessinioti C, Katsambas A. Seborrheic dermatitis: etiology, risk factors, and treatments:: facts and controversies. Clinics in dermatology 2013;31(4):343-51

Bakardzhiev I, Argirov A. New insights into the etiopathogenesis of seborrheic dermatitis. Clin Res Dermatol Open Access 2017;4(1):1-5

Zani M, Soares R, Arruda A, de Arruda L, Paulino L. Ketoconazole does not decrease fungal amount in patients with seborrhoeic dermatitis. British Journal of Dermatology 2016;175(2):417-21

Araya M, Kulthanan K, Jiamton S. Clinical characteristics and quality of life of seborrheic dermatitis patients in a tropical country. Indian journal of dermatology 2015;60(5):519

Dall’Oglio F, Nasca MR, Gerbino C, Micali G. An overview of the diagnosis and management of seborrheic dermatitis. Clinical, Cosmetic and Investigational Dermatology 2022:1537-48

Gupta AK, Madzia S, Batra R. Etiology and management of seborrheic dermatitis. Dermatology 2004;208(2):89-93

Faergemann J, Borgers M, Degreef H. A new ketoconazole topical gel formulation in seborrhoeic dermatitis: an updated review of the mechanism. Expert opinion on pharmacotherapy 2007;8(9):1365-71

Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topical steroids: A long overdue revisit. Indian dermatology online journal 2014;5(4):416

Safarini OA, Patel J. Calcineurin inhibitors. 2020

Jain S, Arora P, Nainwal LM. Essential oils as potential source of anti-dandruff agents: a review. Combinatorial Chemistry & High Throughput Screening 2022;25(9):1411-26

Ayatollahi A, Firooz A, Lotfali E, Mojab F, Fattahi M. Herbal Therapy for the Management of Seborrheic Dermatitis: A Narrative Review. Recent Advances in Anti-Infective Drug Discovery Formerly Recent Patents on Anti-Infective Drug Discovery 2021;16(3):209-26

Hadizadeh-Talasaz F, Mardani F, Bahri N, Rakhshandeh H, Khajavian N, Taghieh M. Effect of Rosemary cream on episiotomy wound healing in primiparous women: A randomized clinical trial. BMC Complementary Medicine and Therapies 2022;22(1):226

Shirbeigi L, Dalfardi B, Abolhassanzadeh Z, Nejatbakhsh F. Dementia etiologies and remedies in traditional Persian medicine; A review of medicinal plants and phytochemistry. Current drug metabolism 2018;19(5):414-23

Hosseinkhani A, Ziaian B, Hessami K, Kashkooe A, Pasalar M. An Evidence-Based Review of Antitussive Herbs Containing Essential Oils in Traditional Persian Medicine. Current Drug Discovery Technologies 2021;18(2):179-85

Memariani Z, Moeini R, Hamedi SS, Gorji N, Mozaffarpur SA. Medicinal plants with antithrombotic property in Persian medicine: a mechanistic review. Journal of thrombosis and thrombolysis 2018;45:158-79

Ait‐Ouazzou A, Lorán S, Bakkali M, et al. Chemical composition and antimicrobial activity of essential oils of Thymus algeriensis, Eucalyptus globulus and Rosmarinus officinalis from Morocco. Journal of the Science of Food and Agriculture 2011;91(14):2643-51

Ayala‐Zavala JF, González‐Aguilar GA, Del‐Toro‐Sánchez L. Enhancing safety and aroma appealing of fresh‐cut fruits and vegetables using the antimicrobial and aromatic power of essential oils. Journal of Food Science 2009;74(7):R84-R91

Bernardes WA, Lucarini R, Tozatti MG, et al. Antibacterial activity of the essential oil from Rosmarinus offi cinalis and its major components against oral pathogens. Zeitschrift für Naturforschung C 2010;65(9-10):588-93

Muyima NO, Nkata L. Inhibition of the growth of dermatophyte fungi and yeast associated with dandruff and related scalp inflammatory conditions by the essential oils of Artemisia afra, Pteronia incana, Lavandula officinalis and Rosmarinus officinalis. Journal of Essential Oil Bearing Plants 2005;8(3):224-32

Tamer F, Yuksel ME, Sarifakioglu E, Karabag Y. Staphylococcus aureus is the most common bacterial agent of the skin flora of patients with seborrheic dermatitis. Dermatology practical & conceptual 2018;8(2):80

Parvizi MM, Fatehi N, Jaladat AM, Gholampour Z, Shahriarirad R, Erfani A. Epidemiological factors in patients with dermatologic conditions referring to the clinic of traditional Persian Medicine: A cross-sectional study. Int J Clin Pract 2021;75(11):e14788 doi: 10.1111/ijcp.14788[published Online First: Epub Date]|.

Parvizi MM, Forouhari S, Shahriarirad R, Shahriarirad S, Bradley RD, Roosta L. Prevalence and associated factors of complementary and integrative medicine use in patients afflicted with COVID-19. BMC Complement Med Ther 2022;22(1):251 doi: 10.1186/s12906-022-03722-x[published Online First: Epub Date]|.

Dastgheib L, Farahangiz S, Adelpour Z, Salehi A. The Prevalence of Complementary and Alternative Medicine Use among Dermatologic Outpatients in Shiraz, Iran. Iran J Med Sci 2016;41(3 Suppl):S70

Niazi M, Mehrabani M, Namazi MR, et al. Efficacy of a topical formulation of henna (Lawsonia inermis L.) in contact dermatitis in patients using prosthesis: A double-blind randomized placebo-controlled clinical trial. Complement Ther Med 2020;49:102316 doi: 10.1016/j.ctim.2020.102316[published Online First: Epub Date]|.

Mojahedi M, Alizadeh M, Kebria AS, Parvizi MM. Successful maintenance treatment of a patient with chronic dermatitis with leech therapy. J Res Med Sci 2023;28:60 doi: 10.4103/jrms.jrms_199_22[published Online First: Epub Date]|.

Parvizi MM, Heydari M, Namazi MR. Successful treatment of chronic scalp seborrheic dermatitis using traditional Persian medicine: a case report and literature review. Galen Medical Journal 2017;6(2):157-59

Mustarichie R, Rostinawati T, Pitaloka DAE, Saptarini NM, Iskandar Y. Herbal Therapy for the Treatment of Seborrhea Dermatitis. Clinical, Cosmetic and Investigational Dermatology 2022:2391-405

Barak-Shinar D, Green LJ. Scalp seborrheic dermatitis and dandruff therapy using a herbal and zinc pyrithione-based therapy of shampoo and scalp lotion. The Journal of clinical and aesthetic dermatology 2018;11(1):26

Panahi Y, Taghizadeh M, Marzony ET, Sahebkar A. Rosemary oil vs minoxidil 2% for the treatment of androgenetic alopecia: a randomized comparative trial. Skinmed 2015;13(1):15-21

Lohrasb MH, Ghodrat M, Meshkibaf MH. Therapeutic Effects of Topical Minoxidil or Rosemary and the Combination of Both on the treatment of Alopecia areata. Journal of Advanced Biomedical Sciences 2014;4(4):475-84

Mangion SE, Mackenzie L, Roberts MS, Holmes AM. Seborrheic dermatitis: Topical therapeutics and formulation design. European Journal of Pharmaceutics and Biopharmaceutics 2023

Ashtiani HA, Rastegar H, Aghaei M, Ehsani A, Barikbin B, Salout MH. Clinical efficacy of natural formulated shampoo in subjects with dandruff and seborrheic dermatitis. American Journal of Research Communication 2013;1(8):63-80

González-Minero FJ, Bravo-Díaz L, Ayala-Gómez A. Rosmarinus officinalis L.(Rosemary): An ancient plant with uses in personal healthcare and cosmetics. Cosmetics 2020;7(4):77

Bidhendi N, Ahmadi Ashtiani H, Ayatollahi A, Yadangi S, Ghorban Dadras O, Firooz A. Comparison of the efficacy and safety of a herbal extract lotion with clotrimazole 1% lotion in the treatment of seborrheic dermatitis: A randomized clinical trial. Dermatology and Cosmetic 2017;7(4):189-99

del Pilar Sánchez-Camargo A, Herrero M. Rosemary (Rosmarinus officinalis) as a functional ingredient: recent scientific evidence. Current Opinion in Food Science 2017;14:13-19

Ojeda-Sana AM, van Baren CM, Elechosa MA, Juárez MA, Moreno S. New insights into antibacterial and antioxidant activities of rosemary essential oils and their main components. Food control 2013;31(1):189-95

Stojiljkovic J, Trajchev M, Nakov D, Petrovska M. Antibacterial activities of rosemary essential oils and their components against pathogenic bacteria. Advances in Cytology & Pathology 2018

Wulandari D, Sopyan I, Ginaris RP, Fathurrohim MF, Maya I. Potential of Essential Oil as Anti-Dandruff in Scalp Treatment Preparations. FITOFARMAKA: Jurnal Ilmiah Farmasi 2022;12(2):156-68

Sumintarti S, Hajrah-Yusuf AS, Ruslin M. Effects of rosemary (Rosmarinus officinalis L.) leaf extract on angular cheilitis induced by staphylococcus aureus and candida albicans in male wistar rats. Int J App Pharm 2018;10(1):178-81

Downloads

Published

2024-10-30

How to Cite

1.
Efficacy of Topical Rosemary Extract Lotion Versus Topical 2% Ketoconazole Lotion in the Treatment of Seborrheic Dermatitis: A Double Blind Randomized Controlled Clinical Trial. Dermatol Pract Concept [Internet]. 2024 Oct. 30 [cited 2024 Dec. 3];14(4):e2024242. Available from: https://dpcj.org/index.php/dpc/article/view/4449

Share